Center Helps Those for Whom Sleep Is an Enemy

By JAY ROMANO

Published: December 29, 1991

NEWARK—
JUDITH M. CULLEN, a systems program analyst, can remember lying in bed, eyes wide open, watching a stranger move about her room in the shadows. Transfixed with fear and unable to move or make a sound, she could only lie and wait silently for the figure to disappear, as it always did, and for control over her body to return.

David Elving Schwartz, a Newark lawyer, recalls driving along the Garden State Parkway when, he says, he felt a wave of fatigue sweep over his body. Struggling to stay awake, he slapped himself, hard, in the face. Then, glancing over at a car beside him, Mr. Schwartz was embarrassed and hurt at seeing the occupants of the other car laughing at him.

Both Mr. Schwartz and Ms. Cullen have narcolepsy, a sleep disorder that manifests itself in the sudden, uncontrollable urges to sleep that Mr. Schwartz experienced, or in the frightening hallucinations and temporary paralysis that left Ms. Cullen exhausted, drained and drenched in sweat.

Mr. Schwartz and Ms. Cullen also have something else in common: they both found help at Newark Beth Israel Hospital's Sleep Disorders Center, the only accredited center of its kind in the state.

The center, which was founded in 1978 by Dr. Monroe S. Karetzky, treats nearly 900 sleep-disordered patients a year. And though about 60 percent of the patients there are referred by other physicians, nearly 40 percent find the center on their own.

"I was popping caffeine pills like they were candy," said Mr. Schwartz, who is a municipal prosecutor in Newark. "It was getting so bad that I was falling asleep even during trials that were fairly interesting."

Realizing that he could no longer control the irrepressible urges to sleep that ruled his life, Mr. Schwartz made an appointment with Dr. Jeffrey S. Nahmias, a Brooklyn-born physician who runs the center. Dr. Nahmias met with the 37-year-old lawyer and invited him to spend a night and a day there.

Shortly afterward, Dr. Nahmias was able to give Mr. Schwartz a name for his problem -- a mild form of narcolepsy -- and a prescription for medication that would allow him to live a normal life in spite of it.

"It's really fascinating," Dr. Nahmias said. "Sometimes while I'm interviewing a patient I have to go out to talk to the secretary. When I come back in, the patient's fallen asleep on me."

Narcolepsy, Dr. Nahmias said, is only one of many sleep disorders that are diagnosed daily at the center. Others include insomnia, sleepwalking, excessive snoring, hallucinations, temporary paralysis and even total loss of muscle control during periods of intense emotion like fear and even joy.

"A lot of people don't even know what a sleep center is," Dr. Nahmias said. "They don't know there's a place to go for help."

When a patient comes in with a problem, Dr. Nahmias said, he will spend at least an hour going over the patient's medical history and a recounting of current sleep problems and "sleep hygiene."

Knowing a patient's sleep habits, Dr. Nahmias said, is essential for diagnosing a potential sleeping disorder. "If you have three cups of coffee and start doing the mamba, then you should know why you can't get to sleep," he said.

If, however, there appears to be a problem that cannot be accounted for, Dr. Nahmias will schedule the patient for a night at the center.

One such patient was Frank Passenti, a 37-year-old East Brunswick resident who went to the center because friends were complaining about his snoring. It had never occurred to Mr. Passenti that his lifelong habit of waking up every two hours was unusual.

"I would wake up gasping for breath," he said. "I would actually stop breathing at night." He had not sought treatment earlier because he thought it happened to everyone. A Night at the Center

"I went to the hospital with my little overnight bag," he said. "They showed me to a little room, I got dressed for bed and then one of the assistants came and stuck these electrodes all over my body and said, 'Good night, we're going to monitor you all night long."

Those electrodes, 18 in all, were connected to a device called a polysomnograph, which monitors everything from eye movements to heart rate to brain waves to muscle tone.

"For the first couple of hours, it was pretty difficult getting to sleep, but when it's time for me to go to sleep, I go to sleep," Mr. Passenti said.

Throughout the night, technicians in the other room monitored the information pouring into the polysomnograph as it sketched 18 twitching ink lines onto a continuous role of graph paper. By the next morning, and nearly a quarter-mile of graph paper later, Dr. Nahmias and his staff had a detailed picture of Mr. Passenti's sleep cycle. Disturbance in Breathing

Like many of the patients he sees who are not aware that they have a sleep disorder, Dr. Nahmias said, Mr. Passenti was diagnosed with one of the more common sleep disorders, obstructive sleep apnea -- a disorder that is caused by a disturbance in the breathing pattern.

Dr. Nahmias said that in patients with sleep apnea, as the sleeper goes into progressively deeper stages of sleep, the tongue falls against the back wall of the throat, blocking the airway. As the sleeper breathes harder to get the oxygen needed, the blockage worsens to the point where there is no longer any air getting into the lungs.